Systematic Review and Meta-Analysis on the Influence of Surgeon Specialisation on Outcomes Following Appendicectomy in Children

(i) General surgeons and paediatric surgeons manage appendicitis in children however the influence of subspecialisation on outcomes remains unclear. (ii) To assess the influence of surgeon specialisation on outcomes following appendicectomy in children. (iii) Two authors searched Medline and Embase to identify relevant studies. Eligible studies were comparative and provided data on children who had appendicectomy while under the care of general or paediatric surgical teams. Twoauthors initially screened titles and abstracts and then full text manuscripts were evaluated. Data were extracted by two authors using an electronic spreadsheet. Pooled risk ratios and pooled mean differences were used in analyses. (iv) We identified nine relevant studies involving 50,963 children who were managed by general surgery teams and 15,032 children who were managed by paediatric surgery teams. A normal appendix was removed in 4660 48105 children treated by general surgery units and in 889 14760 children treated by paediatric units (pooled risk ratio 1.79; 95 % CI 1.262.54; p = 0.001). Children managed in general units had shorter mean hospital stays compared with children managed in paediatric units (pooled mean difference -0.70 days; 95 % CI -1.09 to -0.30; p = 0.0005). There were no significant differences regarding wound infections, intra-abdominal abscesses, readmissions or mortality. (v) We found that children who were managed by specialised paediatric surgery teams had lower rates of negative appendicectomy although mean length of stay was longer. Our review is based upon a group of heterogeneous and mostly retrospective studies and therefore there is little external validity. Further studies are needed